Introduction

Dementia isn’t a disorder in itself; rather, it’s a combination of symptoms that affect the memory, speech, decision-making, learning, and understanding abilities of a person, making it really hard for them to perform daily tasks. These symptoms develop slowly and get progressively worse over time, eventually leading to dementia. It affects people mostly over the age of 65, but it’s important to remember that dementia is not an inevitable part of ageing.¹

People with dementia often find it hard to communicate, whether it's speaking, reading, writing, or understanding. When interacting with them, it's crucial to adapt your communication approach to make things easier and less stressful for them. By showing empathy and avoiding any sense of blame for their struggles, you can create a more supportive environment for both of you.^1,2

This article will look at how dementia impacts communication and offer tips for having more effective interactions with those affected.

How does dementia affect communication?

As mentioned before, people with dementia often have trouble expressing their thoughts and making sense of the messages directed towards them. 

You might observe various ways in which communication is affected in different people with dementia, such as:^1,3,4

• Struggling to find the right words to speak
• Difficulty pronouncing words correctly
• Finding humour or sarcasm hard to understand
• Difficulty holding multiple thoughts at a time, often switching between topics quickly
• Difficulty maintaining a conversation in loud surroundings
• Frequently repeating the same phrases, questions, or actions
• Losing track of words halfway through a sentence
• Having trouble reading or writing
• Mixing up words, like saying ‘glass’ instead of ‘window’
• Mumbling, stuttering, and using wrong words or phrases, such as saying ‘bathroom’ when they mean ‘kitchen’
• Forgetting the names of family members or having difficulty recognising them 
• Imitating you or sometimes following you everywhere you go, even to the bathroom
• Not responding to your questions or actions at all

Why does dementia affect communication?

Dementia can result from various causes or conditions, depending on the part of the brain that is affected. Communication difficulties in dementia patients primarily stem from the gradual destruction of brain nerve cells, causing damage to the brain over a period of time. Consequently, their speech and actions are altered, along with shifts in behaviour, personality, and emotional responses.^1,5

In dementia patients, other factors that could further impact communication might include

• side effects of dementia medications
• vision or hearing difficulties
• potential additional health conditions

If you notice any of these factors worsening communication in your loved one with dementia, it's essential to reach out to a GP for guidance.

Why is communication important for a person with dementia?

In dementia patients, good communication can enhance quality of life, reduce feelings of frustration or isolation, and foster a sense of dignity and understanding. It also empowers them to be involved in making decisions and maintaining meaningful bonds with family and friends.⁶

As dementia advances, communication with your loved one may become more challenging, but you can still discover ways to connect deeply and meaningfully with them. Positive communication helps dementia patients in uphold their self-respect and feel valued.^6,7

How can you effectively interact with someone who has dementia?

We communicate not only with words but also with our body language, facial expressions, and the tone of our voice. When interacting with a person who has dementia, showing kindness and care through your body language is important. For example, maintaining eye contact and offering a warm smile can help create a sense of connection and reassurance for them.³

Here are some helpful tips for having effective and meaningful interactions with dementia patients:

Create the ideal environment

Before starting a conversation with a dementia patient, make sure that:^3,8

• The environment is comfortable for them.
• You’re in a calm place with good lighting.
• The environment is less busy and noisy. 
• There are no distractions like TV or radio, so it's easier for them to concentrate. 
• You have the person’s complete attention before beginning.
• They’re not hungry or in pain.

Maintain positive body language 

As dementia progresses, patients may increasingly rely on non-verbal communication, which can eventually become their primary mode of communication. Therefore, it is important to maintain positive body language while interacting with them. This includes:^3,8

• Make eye contact before speaking.
• Standing or sitting at their level while talking.
• Smiling while communicating.
• Nodding while they’re talking.
• Use hand gestures and other visual signs to help convey your message.
• Gently holding their hand or maintaining contact, where appropriate.
• Avoiding actions like rolling eyes or sighing, which might give the impression that you’re annoyed with them.

Speak slowly and clearly to help the patient understand

Those affected by dementia often struggle to understand and process complex information, especially as their symptoms worsen. Therefore, to effectively communicate  your message, you must:^7,8,9

• Use simple and short sentences. 
• Speak in a gentle and respectful tone.
• If the patient looks confused, try putting the question differently.
• Make sure that only one person speaks at a time, if there are several people present.
• Allow the patient at least 10-20 seconds to process and respond to what you’ve asked.
• Respond patiently and calmly to repeated questions, avoiding phrases like "I just told you that".
• Use simple phrases such as “getting married” instead of complex ones like “tying the knot’’.
• Beginning sentences with specific names or labels may help sometimes, e.g., “Your granddaughter, Harsheta”.
• Show pictures to help convey your message, such as a photo of where you're going or who you're visiting.
• People with dementia may struggle to recognise you right away. Take a moment to gently remind them of your name and your relationship with them. For example, saying, “It’s me, mom, your son, Phil”, may trigger memories and provide a sense of security for them.

Actively listen to and validate the patient’s feelings

As a caregiver or a family member, you must actively listen and validate the emotions behind what's being said by the dementia patient, rather than just focusing on facts. This makes them feel respected and understood. For example:^3,7,8,9

• Always believe that whatever the patient is saying conveys some meaning.
• Acknowledge the patient's emotions, thoughts, and feelings, in a context that feels real to them for example, if the patient says, ‘I miss my dad’, then talk to them about it, such as, ‘I’m sure you miss your dad.’, ‘Do you want to share a memory you have with him?’; this will provide reassurance to them and make them feel safe and comfortable.
• Engage with their life stories, and encourage participation in tasks that align with their past interests and skills. 
• Listen to them with empathy to reduce anxiety and build trust.
• Avoid criticising them or arguing with them if they think something is true, even if you know it isn’t.
• It's normal for dementia patients to remember something in the morning but forget it by the evening; Understand that this is not intentional or manipulative on their part.

Choose appropriate words and behaviour for communicating

When communicating with someone who has dementia, you must use appropriate words and actions that are easy for them to understand and are familiar to them. For instance:^3,8,9,10

• Treat the person with dementia as an adult, don’t look down on them.
• Don’t adopt a controlling/commanding tone or behaviour with the patient.
• Try redirecting the topic to something else if the interaction is not going well, or if the patient is getting frustrated.
• If they have trouble recalling a word, offer some suggestions, but don't jump in to finish their sentences.
• Avoid asking too many questions as it might pressurise them to respond, instead offer suggestions, such as, "Let's listen to some calming music" or "How about flipping through a photo album?".
• Refrain from asking open-ended questions, for example, instead of asking, “What do you want to eat?”, ask, “Would you like to have soup or a sandwich for dinner?”.
• Use reassuring and compassionate words to interact. 

Take care of yourself too

Balancing the demands of caregiving for someone with dementia with your personal well-being can be overwhelming, often leading to sleepless nights and neglected self-care. Amidst this, it’s important to be kind to yourself and look after your own needs too.¹¹

Here are some self-care tips:¹¹ 

• Join a carer’s support group. 
• Take breaks throughout the day. 
• Take out time for your hobbies every day.
• Eat a balanced diet.
• Exercise regularly. 
• Go out with your family and friends often.
• Feel free to reach out for help when needed.

It's okay to forgive yourself when you feel like you've made the wrong choices in a situation, possibly causing more distress for your loved one with dementia. Wrong judgments are a natural part of the journey, and it's important not to dwell on guilt. Instead, focus on learning from these experiences and responding differently next time. Don't forget, that taking care of yourself matters just as much as caring for your loved one.

Summary

As dementia advances, communicating with your loved ones may become increasingly challenging, leaving you both feeling frustrated. However, it’s important to remember that they can't change how they communicate. Therefore, you must adapt your method of interacting with them to help them feel heard and cared for. Being kind and patient in your conversations can make a big difference in supporting your loved ones through their dementia journey. Additionally, seeking help from dedicated organisations, local support groups, or your healthcare professional can make navigating this journey easier for both of you.